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HMSA Neighborhood Centers

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2018 Medicare Low–Income Subsidy

Find out if you qualify for a Low-Income Subsidy (LIS) — also known as Extra Help — to help pay
for your premiums and prescription drug copayments.

How to apply

Apply for LIS at the Social Security Administration (SSA) or your state Medicaid agency.
Complete an online application at ssa.gov
or call the SSA Monday through Friday, 7 a.m. to 7 p.m., at 1-800-772-1213
toll-free. For TTY, call 1-800-325-0778.

How LIS changes your premiums and copayments

If you qualify, Medicare will tell us about your LIS eligibility and we'll apply it to your health plan
benefits to reduce your out-of-pocket costs. You can also tell us about your LIS by showing us your
Medicaid card or your award letter from SSA, called Best Available Evidence.
Learn more about Best Available Evidence at the CMS website at
cms.gov.

* Copayment amounts for generic/preferred multi-source and other drugs, respectively. For example, the first amount shown ($3.35) is the copayment for a generic drug filled for a member in the LIS Category 1.

** After the true-out-of-pocket limit is reached, the Catastrophic copayment for LIS Levels 1, 2, and 3 is $0 for both generic and brand drugs. The Catastrophic copayments for LIS Level 4 are $3.35 for generic/preferred multi-source drugs and $8.35 for other drugs.

HMSA Akamai Advantage is a PPO and Essential Advantage is an HMO plan with a Medicare contract. Enrollment in HMSA Akamai Advantage and Essential Advantage depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information.
Limitations, copayments, and restrictions may apply.
Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year.